Provider Demographics
NPI:1083849541
Name:SUNSHINE INFANTS TODDLERS EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:SUNSHINE INFANTS TODDLERS EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEYMORE-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:718-671-6885
Mailing Address - Street 1:120 ELGAR PL APT 3K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5149
Mailing Address - Country:US
Mailing Address - Phone:718-671-6885
Mailing Address - Fax:
Practice Address - Street 1:120 ELGAR PL
Practice Address - Street 2:SUITE # 3 K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5149
Practice Address - Country:US
Practice Address - Phone:718-671-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009439252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205080256OtherSOLE PROPRIETOR